Zambia Confronts TB Among Women With HIV

LUSAKA, Zambia (WOMENSENEWS)–Justina Banda, 44, says that because she is HIV-positive she is extra prone to tuberculosis. She has had TB three times, most recently last year.

Though she has completed her TB treatment, she says she often feels sick and is scared that she might have another relapse. She is going for a TB review in a few days.

Banda rents a one-room apartment in Kanyama, the most densely populated area west of Lusaka, the capital. She says crime, poverty and unemployment plague the area. Its residents live in tiny houses that are linked together and lack proper ventilation and access to clean water.

She shares the one room with her husband and their six children, some who are in their late teens. The tiny room with one small window is their bedroom, kitchen and living room.

Banda, who learned she had HIV two years ago, says her struggle with TB began in 1996. She underwent treatment but got it again in 1999 and 2010.

"I was told to eat a balanced diet, but hunger is part of our life," she says.

TB is a leading cause of death among people living with HIV here, according to Justin O’Brien, policy, advocacy and communications manager for The Zambia AIDS Related Tuberculosis Project, ZAMBART, a nongovernmental organization that aims to improve the quality of life of people with HIV and TB. About 70 percent of Zambian TB patients have HIV, according to the World Health Organization.

TB levels are high among HIV patients because of their weakened immune systems, said Dr. Nathan Kapata, national TB and leprosy program manager for the Ministry of Health, in the Times of Zambia, a newspaper here. TB, caused by a germ in the lungs that can be spread when an infected person coughs or sneezes, is easily passed among people living closely together, said Kapata in the Zambia Daily Mail, another newspaper here.

Dr. Peter Chungulo of ZAMBART says that poverty and malnutrition, or undernutrition, also contribute to TB infections, whether it’s new cases or relapses.

Banda’s face looks dehydrated. She says she is weak because she can’t afford to eat three meals a day.

"Sometimes it’s a challenge to take both TB and HIV drugs on an empty stomach," Banda says. "I struggle to eat required food for a TB patient because I don’t have any source of income."

She knits plastic threads into a handbag, which she aims to sell to raise a few kwachas, the currency here. She used to crush stone and sell charcoal, but her doctors advised her to stop.

"I struggle to work, as I feel weak and my back pains severely," Banda says. "My children cannot go to school because we cannot [afford] to take them to school."

Concerns About Children

Her second youngest child, the only one who is HIV-positive, was diagnosed with TB last year but has recovered. She says she still worries about her children’s health and providing them food.

"None of us knows how I acquired the virus, but I remember washing other people’s clothes, which had blood," she says.

Banda washes other people’s clothes as a source of income. She says she hopes she doesn’t have another TB relapse because she is her family’s breadwinner. Her husband, 58, who is HIV-negative, is unemployed and too old to find work.

"I get tired of taking the TB drugs," she says. "It paralyzes my duties. I wish there was a way I can avoid getting infected."

Stella Maliwa, who is HIV-positive and the secretary for Langa, a local HIV support group, says many women living with HIV are extra prone to TB because they are the primary caregivers for chronically ill TB patients. The women lack protective garments and the patients’ houses have poor ventilation, making TB transmission risks high.

Developing Prevention Strategies

The government, nongovernmental organizations and support groups are working to prevent new TB cases and relapses.

The Strengthening TB, AIDS and Malaria Prevention Programme, STAMPP, aims to strengthen the existing prevention, treatment and care strategies. Chungulo from ZAMBART says his organization has been implementing isoniazid prevention therapy, considered the first line of defense against TB, for STAMPP.

The National TB Control Programme has also been successfully implemented, thanks to the government, which has ensured the availability of drugs and diagnostic equipment recommended by the World Health Organization, according to Kapata in the Times of Zambia.

TB drugs are free, but there is a minimum laboratory free to test one’s sputum – the mucus and other matter brought up from the infected lungs, bronchi and trachea.

Zambia has attained its target of 85 percent for its TB treatment success rate in recent years, according to a 2010 U.N. report. But the report cautioned that adequate resources are necessary to sustain progress and tackle the root causes of HIV/AIDS and TB in order to meet goal six of the Millennium Development Goals, a global anti-poverty initiative, to reduce these diseases by 2015.

The Sixth National Development Plan 2011-2015 emphasizes TB research and aims to expand access to appropriate care, support and treatment for people living with HIV/AIDS, their caregivers and their families – including services for TB.

Chungulo says TB can be reduced here with a special focus on vulnerable groups and implementation of the three I’s: intensified case finding, isoniazid prevention therapy and infection control. ZAMBART aims to partner with the Ministry of Health to implement them and other TB-HIV initiatives nationwide.

Support groups are also working to empower women with HIV and TB here. Banda says she joined the Langa support group to gain knowledge about TB prevention and to learn how to earn a better living to improve her and her family’s health.

"I hope to find a source of income and live in an environment where I will be free from TB relapse," Banda says.

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